Female vs. male relative fatality risk in fatal motor vehicle crashes in the US, 1975-2020

Motor vehicle accidents are the leading cause of death for young adults 18-29 years old worldwide, resulting in nearly 1 million years of life lost annually in the United States. Despite improvements in vehicle safety technologies, young women are at higher risk of dying in car crashes compared with men in matched scenarios. Vehicle crash testing primarily revolves around test dummies representative of the 50th percentile adult male, potentially resulting in these differences in fatality risk for female occupants compared to males. Vehicle occupants involved in fatal car crashes were matched using seating location, vehicle type, airbag deployment, seatbelt usage, and age. The relative risk for fatality (R) between males and females was calculated using a Double Pair Comparison. Young women (20s-40s) are at approximately 20% higher risk of dying in car crashes compared with men of the same age in matched scenarios. In passenger cars, 25-year-old female occupants in passenger car crashes from 1975-2020 exhibit R = 1.201 (95% CI 1.160-1.250) compared to 25-year-old males, and R-1.117 (95% CI 1.040-1.207) for passenger car crashes from 2010-2020. This trend persists across vehicle type, airbag deployment, seatbelt use, and number of vehicles involved in a crash. Known sex-based differences do not explain this large risk differential, suggesting a need for expanded test methodologies and research strategies to address as-yet unexplored sex differences in crash fatalities. These differences should be further investigated to ensure equitable crash protection.

Facial Fracture Injury Criteria from Night Vision Goggle Impact

INTRODUCTION: Military personnel extensively use night vision goggles (NVGs) in contemporary scenarios. Since NVGs may induce or increase injuries from falls or vehicular accidents, biomechanical risk assessments would aid design goal or mitigation strategy development.METHODS: This study assesses injury risks from NVG impact on cadaver heads using impactors modeled on the PVS-14 NVG. Impacts to the zygoma and maxilla were performed at 20° or 40° angles. Risks of facial fracture, neurotrauma, and neck injury were assessed. Acoustic sensors and accelerometers assessed time of fracture and provided input variables for injury risk functions. Injuries were assessed using the Abbreviated Injury Scale (AIS); injury severity was assessed using the Rhee and Donat scales. Risk functions were developed for the input variables using censored survival analyses.RESULTS: The effects of impact angle and bone geometry on injury characteristics were determined with loading area, axial force, energy attenuation, and stress at fracture. Probabilities of facial fracture were quantified through survival analysis and injury risk functions. These risk functions determined a 50% risk of facial bone fracture at 1148 N (axial force) at a 20° maxillary impact, 588 N at a 40° maxillary impact, and 677 N at a 20° zygomatic impact. A cumulative distribution function indicates 769 N corresponds to 50% risk of fracture overall.DISCUSSION: Results found smaller impact areas on the maxilla are correlated with higher angles of impact increasing risk of facial fracture, neck injuries are unlikely to occur before fracture or neurotrauma, and a potential trade-off mechanism between fracture and brain injury.Davis MB, Pang DY, Herring IP, Bass CR. Facial fracture injury criteria from night vision goggle impact. Aerosp Med Hum Perform. 2023; 94(11):827-834.

Using Wavelet Analysis to Distinguish Cavitation Acoustic Emissions From Blunt Impact Noise

Cavitation has been shown to have implications for head injury, but currently there is no solution for detecting the formation of cavitation through the skull during blunt impact. The goal of this communication is to confirm the wideband acoustic wavelet signature of cavitation collapse, and determine that this signature can be differentiated from the noise of a blunt impact. A controlled, laser induced cavitation study was conducted in an isolated water tank to confirm the wide band acoustic signature of cavitation collapse in the absence of a blunt impact. A clear acrylic surrogate head was impacted to induce blunt impact cavitation. The bubble formation was imaged using a high speed camera, and the collapse was synched up with the wavelet transform of the acoustic emission. Wideband acoustic response is seen in wavelet transform of positive laser induced cavitation tests, but absent in laser induced negative controls. Clear acrylic surrogate tests showed the wideband acoustic wavelet signature of collapse can be differentiated from acoustic noise generated by a blunt impact. Broadband acoustic signal can be used as a biomarker to detect the incidence of cavitation through the skull as it consists of frequencies that are low enough to potentially pass through the skull but high enough to differentiate from blunt impact noise. This lays the foundation for a vital tool to conduct CSF cavitation research in-vivo.

Time and temperature sensitivity of the hybrid III lumbar spine

OBJECTIVE

Researchers have found a variety of uses for the Hybrid III (HIII) dummy that fall beyond the scope of its original purpose as an automotive crash test dummy. Some of these expanded roles for the HIII introduce situations that were not envisioned in the dummy's original design parameters, such as a relatively rapid succession of tests or outdoor testing scenarios where temperature is not easily controlled. This study investigates how the axial compressive stiffness of the HIII lumbar spine component is affected by the duration of the time interval between tests. Further, it measures the effect of temperature on the compressive stiffness of the lumbar spine through a range of temperatures relevant to indoor and outdoor testing.

METHODS

High-rate axial compression tests were run on a 50^th percentile male HIII lumbar component in a materials testing machine. To characterize the effects of tests recovery intervals, between-test recovery was varied from 2 hours to 1 minute. To quantify temperature effects, environmental temperature conditions of 12.5°, 25°, and 37.5 °C were tested.

RESULTS

During repeated compressive loading, the force levels decreased consistently across long and short rest intervals. Even after 2 hours of rest between tests, full viscoelastic recovery was not observed. Temperature effects were pronounced, resulting in compressive force differences of 261% over the range of 12.5° to 37.5 °C. Compared to the stiffness of the lumbar at 25 °C, the stiffness at 37.5 °C fell by 40%; at 12.5 °C, the stiffness more than doubled, increasing by 115%.

CONCLUSIONS

A modest decrease in temperature can be sufficient to dramatically change the response and repeatability of the lumbar HIII component in compressive loading. The large magnitude of the temperature effect has severe implications in its ability to overwhelm the contributions of targeted test variables. These findings highlight the importance of controlling, monitoring and reporting temperature conditions during HIII testing, even in indoor laboratory environments.

Acoustic emissions in vertebral cortical shell failure

Understanding the initiation of bony failure is critical in assessing the progression of bone fracture and in developing injury criteria. Detection of acoustic emissions in bone can be used to identify fractures more sensitively and at an earlier inception time compared to traditional methods. However, high rate loading conditions, complex specimen-device interaction or geometry may cause other acoustic signals. Therefore, characterization of the isolated local acoustic emission response from cortical bone fracture is essential to distinguish its characteristics from other potential acoustic sources. This work develops a technique to use acoustic emission signals to determine when cortical bone failure occurs by characterization using both a Welch power spectral density estimate and a continuous wavelet transform. Isolated cortical shell specimens from thoracic vertebral bodies with attached acoustic sensors were subjected to quasistatic loading until failure. The resulting acoustic emissions had a wideband frequency response with peaks from 20 to 900 kHz, with the spectral peaks clustered in three bands of frequencies (166 ± 52.6 kHz, 379 ± 37.2 kHz, and 668 ± 63.4 kHz). Using these frequency bands, acoustic emissions can be used as a monitoring tool in biomechanical spine testing, distinguishing bone failure from structural response. This work presents a necessary set of techniques for effectively utilizing acoustic emissions to determine the onset of cortical bone fracture in biological material testing. Acoustic signatures can be developed for other cortical bone regions of interest using the presented methods.

Primary blast wave protection in combat helmet design: A historical comparison between present day and World War I

Since World War I, helmets have been used to protect the head in warfare, designed primarily for protection against artillery shrapnel. More recently, helmet requirements have included ballistic and blunt trauma protection, but neurotrauma from primary blast has never been a key concern in helmet design. Only in recent years has the threat of direct blast wave impingement on the head-separate from penetrating trauma-been appreciated. This study compares the blast protective effect of historical (World War I) and current combat helmets, against each other and 'no helmet' or bare head, for realistic shock wave impingement on the helmet crown. Helmets included World War I variants from the United Kingdom/United States (Brodie), France (Adrian), Germany (Stahlhelm), and a current United States combat variant (Advanced Combat Helmet). Helmets were mounted on a dummy head and neck and aligned along the crown of the head with a cylindrical shock tube to simulate an overhead blast. Primary blast waves of different magnitudes were generated based on estimated blast conditions from historical shells. Peak reflected overpressure at the open end of the blast tube was compared to peak overpressure measured at several head locations. All helmets provided significant pressure attenuation compared to the no helmet case. The modern variant did not provide more pressure attenuation than the historical helmets, and some historical helmets performed better at certain measurement locations. The study demonstrates that both historical and current helmets have some primary blast protective capabilities, and that simple design features may improve these capabilities for future helmet systems.

Assessing Surgical Task Load and Performance: A Comparison of Simulation and Maritime Operation

INTRODUCTION

This study examined the effects of simulated and actual vessel motion at high seas on task load and surgical performance.

METHODS

This project was performed in phases. Phase I was a feasibility study. Phase II utilized a motion base simulator to replicate vessel motion. Phase III was conducted aboard the U.S. Naval Ship Brunswick. After performing surgical tasks on a surgical simulation mannequin, participants completed the Surgical Task Load Index (TLX) designed to collect workload data. Simulated surgeries were evaluated by subject matter experts.

RESULTS

TLX scores were higher in Phase III than Phase II, particularly at higher sea states. Surgical performance was not significantly different between Phase II (84%) and Phase III (89%). Simulated motions were comparable in both phases.

CONCLUSIONS

Simulated motion was not associated with a significant difference in surgical performance or deck motion, suggesting that this simulator replicates the conditions experienced during surgery at sea on the U.S. Naval Ship Brunswick. However, Surgical TLX scores were dramatically different between the two phases, suggesting increased workload at sea, which may be the result of time at sea, the stress of travel, or other factors. Surgical performance was not affected by sea state in either phase.

On the relative importance of bending and compression in cervical spine bilateral facet dislocation

BACKGROUND

Cervical bilateral facet dislocations are among the most devastating spine injuries in terms of likelihood of severe neurological sequelae. More than half of patients with tetraparesis had sustained some form of bilateral facet fracture dislocation. They can occur at any level of the sub-axial cervical spine, but predominate between C5 and C7. The mechanism of these injuries has long been thought to be forceful flexion of the chin towards the chest. This "hyperflexion" hypothesis comports well with intuition and it has become dogma in the clinical literature. However, biomechanical studies of the human cervical spine have had little success in producing this clinically common and devastating injury in a flexion mode of loading.

METHODS

The purpose of this manuscript is to review the clinical and engineering literature on the biomechanics of bilateral facet dislocations and to describe the mechanical reasons for the causal role of compression, and the limited role of head flexion, in producing bilateral facet dislocations.

FINDINGS

Bilateral facet dislocations have only been produced in experiments where compression is the primary loading mode. To date, no biomechanical study has produced bilateral facet dislocations in a whole spine by bending. Yet the notion that it is primarily a hyper-flexion injury persists in the clinical literature.

INTERPRETATION

Compression and compressive buckling are the primary causes of bilateral facet dislocations. It is important to stop using the hyper-flexion nomenclature to describe this class of cervical spines injuries because it may have a detrimental effect on designs for injury prevention.

The role of cervical muscles in mitigating concussion

OBJECTIVES

Increased neck strength has been hypothesized to lower sports related concussion risk, but lacks experimental evidence. The goal is to investigate the role cervical muscle strength plays in blunt impact head kinematics and the biofidelity of common experimental neck conditions. We hypothesize head kinematics do not vary with neck activation due to low short term human head-to-neck coupling; because of the lack of coupling, free-head experimental conditions have higher biofidelity than Hybrid III necks.

METHODS

Impacts were modeled using the Duke University Head and Neck Model. Four impact types were simulated with six neck conditions at eight impact positions. Peak resultant linear acceleration, peak resultant angular acceleration, Head Injury Criterion, and Head Impact Power compared concussion risk. To determine significance, maximum metric difference between activation states were compared to critical effect sizes (literature derived differences between mild and severe impact metrics).

RESULTS

Maximum differences between activation conditions did not exceed critical effect sizes. Kinematic differences from impact location and strength can be ten times cervical muscle activation differences. Hybrid III and free-head linear acceleration metrics were 6±1.0% lower and 12±1.5% higher than relaxed condition respectively. Hybrid III and free-head angular acceleration metrics were 12±4.0% higher and 2±2.7% lower than relaxed condition respectively.

CONCLUSIONS

Results from a validated neck model suggest increased cervical muscle force does not influence short term (<50ms) head kinematics in four athletically relevant scenarios. Impact location and magnitude influence head kinematics more than cervical muscle state. Biofidelic limitations of both Hybrid III and free-head experimental conditions must be considered.

Pre-Clinical Testing of Therapies for Traumatic Brain Injury

Despite the large number of promising neuroprotective agents identified in experimental traumatic brain injury (TBI) studies, none has yet shown meaningful improvements in long-term outcome in clinical trials. To develop recommendations and guidelines for pre-clinical testing of pharmacological or biological therapies for TBI, the Moody Project for Translational Traumatic Brain Injury Research hosted a symposium attended by investigators with extensive experience in pre-clinical TBI testing. The symposium participants discussed issues related to pre-clinical TBI testing including experimental models, therapy and outcome selection, study design, data analysis, and dissemination. Consensus recommendations included the creation of a manual of standard operating procedures with sufficiently detailed descriptions of modeling and outcome measurement procedures to permit replication. The importance of the selection of clinically relevant outcome variables, especially related to behavior testing, was noted. Considering the heterogeneous nature of human TBI, evidence of therapeutic efficacy in multiple, diverse (e.g., diffuse vs. focused) rodent models and a species with a gyrencephalic brain prior to clinical testing was encouraged. Basing drug doses, times, and routes of administration on pharmacokinetic and pharmacodynamic data in the test species was recommended. Symposium participants agreed that the publication of negative results would reduce costly and unnecessary duplication of unsuccessful experiments. Although some of the recommendations are more relevant to multi-center, multi-investigator collaborations, most are applicable to pre-clinical therapy testing in general. The goal of these consensus guidelines is to increase the likelihood that therapies that improve outcomes in pre-clinical studies will also improve outcomes in TBI patients.

Long-term complications of glycogen storage disease type Ia in the canine model treated with gene replacement therapy

BACKGROUND

Glycogen storage disease type Ia (GSD Ia) in dogs closely resembles human GSD Ia. Untreated patients with GSD Ia develop complications associated with glucose-6-phosphatase (G6Pase) deficiency. Survival of human patients on intensive nutritional management has improved; however, long-term complications persist including renal failure, nephrolithiasis, hepatocellular adenomas (HCA), and a high risk for hepatocellular carcinoma (HCC). Affected dogs fail to thrive with dietary therapy alone. Treatment with gene replacement therapy using adeno-associated viral vectors (AAV) expressing G6Pase has greatly prolonged life and prevented hypoglycemia in affected dogs. However, long-term complications have not been described to date.

METHODS

Five GSD Ia-affected dogs treated with AAV-G6Pase were evaluated. Dogs were euthanized due to reaching humane endpoints related to liver and/or kidney involvement, at 4 to 8 years of life. Necropsies were performed and tissues were analyzed.

RESULTS

Four dogs had liver tumors consistent with HCA and HCC. Three dogs developed renal failure, but all dogs exhibited progressive kidney disease histologically. Urolithiasis was detected in two dogs; uroliths were composed of calcium oxalate and calcium phosphate. One affected and one carrier dog had polycystic ovarian disease. Bone mineral density was not significantly affected.

CONCLUSIONS

Here, we show that the canine GSD Ia model demonstrates similar long-term complications as GSD Ia patients in spite of gene replacement therapy. Further development of gene therapy is needed to develop a more effective treatment to prevent long-term complications of GSD Ia.

Time and temperature sensitivity of the Hybrid III neck

The Hybrid III (HIII) dummy is one of the most widely used anthropomorphic test devices (ATDs) in the world, and researchers have found a variety of uses for it outside of its original purpose as an automotive crash test dummy. These expanded roles have introduced situations outside the dummy's original design parameters, where a number of tests must be run in relatively rapid succession or where it may not be possible to control the temperature of the test environment.

OBJECTIVE

This study has 2 aims. The first is to determine how the duration of the time interval between tests affects the axial compression performance of the HIII neck. The second is to quantify the effect of temperature on the neck's compressive stiffness through a range of temperatures relevant to indoor or outdoor testing.

METHODS

To characterize the effects of different test conditions, a series of high-rate axial compressive tests was run on a 50th percentile male HIII neck component in a materials testing machine. Between-test recovery intervals were varied from 2 h to 1 min, and temperature conditions of 0, 12.5, 25, and 37.5 °C were tested.

RESULTS

Though the duration of the recovery interval had little impact on the recorded force (less than 1%), the component did exhibit considerable strain creep over the course of the test. Temperature had a strong influence on the compressive stiffness of the component. Compared to the stiffness at 25 °C (near room temperature), the stiffness of the neck at 37.5 °C fell by 15%; at 0 °C, the stiffness more than doubled.

CONCLUSIONS

This study demonstrates that though the duration of the recovery interval between tests has a small influence on neck stiffness, temperature effects should not be overlooked because they influence neck compressive stiffness considerably. The relationship between recorded force and temperature is well represented by exponential decay models. These findings highlight the importance of monitoring and controlling for temperature effects during all HIII testing.

Foul tip impact attenuation of baseball catcher masks using head impact metrics

Currently, no scientific consensus exists on the relative safety of catcher mask styles and materials. Due to differences in mass and material properties, the style and material of a catcher mask influences the impact metrics observed during simulated foul ball impacts. The catcher surrogate was a Hybrid III head and neck equipped with a six degree of freedom sensor package to obtain linear accelerations and angular rates. Four mask styles were impacted using an air cannon for six 30 m/s and six 35 m/s impacts to the nasion. To quantify impact severity, the metrics peak linear acceleration, peak angular acceleration, Head Injury Criterion, Head Impact Power, and Gadd Severity Index were used. An Analysis of Covariance and a Tukey’s HSD Test were conducted to compare the least squares mean between masks for each head injury metric. For each injury metric a P-Value less than 0.05 was found indicating a significant difference in mask performance. Tukey’s HSD test found for each metric, the traditional style titanium mask fell in the lowest performance category while the hockey style mask was in the highest performance category. Limitations of this study prevented a direct correlation from mask testing performance to mild traumatic brain injury.

Air blast injuries killed the crew of the submarine H.L. Hunley

The submarine H.L. Hunley was the first submarine to sink an enemy ship during combat; however, the cause of its sinking has been a mystery for over 150 years. The Hunley set off a 61.2 kg (135 lb) black powder torpedo at a distance less than 5 m (16 ft) off its bow. Scaled experiments were performed that measured black powder and shock tube explosions underwater and propagation of blasts through a model ship hull. This propagation data was used in combination with archival experimental data to evaluate the risk to the crew from their own torpedo. The blast produced likely caused flexion of the ship hull to transmit the blast wave; the secondary wave transmitted inside the crew compartment was of sufficient magnitude that the calculated chances of survival were less than 16% for each crew member. The submarine drifted to its resting place after the crew died of air blast trauma within the hull.

Phosphodiesterase-4 inhibition restored hippocampal long term potentiation after primary blast

Due to recent military conflicts and terrorist attacks, blast-induced traumatic brain injury (bTBI) presents a health concern for military and civilian personnel alike. Although secondary blast (penetrating injury) and tertiary blast (inertia-driven brain deformation) are known to be injurious, the effects of primary blast caused by the supersonic shock wave interacting with the skull and brain remain debated. Our group previously reported that in vitro primary blast exposure reduced long-term potentiation (LTP), the electrophysiological correlate of learning and memory, in rat organotypic hippocampal slice cultures (OHSCs) and that primary blast affects key proteins governing LTP. Recent studies have investigated phosphodiesterase-4 (PDE4) inhibition as a therapeutic strategy for reducing LTP deficits following inertia-driven TBI. We investigated the therapeutic potential of PDE4 inhibitors, specifically roflumilast, to ameliorate primary blast-induced deficits in LTP. We found that roflumilast at concentrations of 1nM or greater prevented deficits in neuronal plasticity measured 24h post-injury. We also observed a therapeutic window of at least 6h, but <23h. Additionally, we investigated molecular mechanisms that could elucidate this therapeutic effect. Roflumilast treatment (1nM delivered 6h post-injury) significantly increased total AMPA glutamate receptor 1 (GluR1) subunit expression, phosphorylation of the GluR1 subunit at the serine-831 site, and phosphorylation of stargazin at the serine-239/240 site upon LTP induction, measured 24h following injury. Roflumilast treatment significantly increased PSD-95 regardless of LTP induction. These findings indicate that further investigation into the translation of PDE4 inhibition as a therapy following bTBI is warranted.

Male and Female Cervical Spine Biomechanics and Anatomy: Implication for Scaling Injury Criteria

There is an increased need to develop female-specific injury criteria and anthropomorphic test devices (dummies) for military and automotive environments, especially as women take occupational roles traditionally reserved for men. Although some exhaustive reviews on the biomechanics and injuries of the human spine have appeared in clinical and bioengineering literatures, focus has been largely ignored on the difference between male and female cervical spine responses and characteristics. Current neck injury criteria for automotive dummies for assessing crashworthiness and occupant safety are obtained from animal and human cadaver experiments, computational modeling, and human volunteer studies. They are also used in the military. Since the average human female spines are smaller than average male spines, metrics specific to the female population may be derived using simple geometric scaling, based on the assumption that male and female spines are geometrically scalable. However, as described in this technical brief, studies have shown that the biomechanical responses between males and females do not obey strict geometric similitude. Anatomical differences in terms of the structural component geometry are also different between the two cervical spines. Postural, physiological, and motion responses under automotive scenarios are also different. This technical brief, focused on such nonuniform differences, underscores the need to conduct female spine-specific evaluations/experiments to derive injury criteria for this important group of the population.

Effect of the mandible on mouthguard measurements of head kinematics

Wearable sensors are becoming increasingly popular for measuring head motions and detecting head impacts. Many sensors are worn on the skin or in headgear and can suffer from motion artifacts introduced by the compliance of soft tissue or decoupling of headgear from the skull. The instrumented mouthguard is designed to couple directly to the upper dentition, which is made of hard enamel and anchored in a bony socket by stiff ligaments. This gives the mouthguard superior coupling to the skull compared with other systems. However, multiple validation studies have yielded conflicting results with respect to the mouthguard׳s head kinematics measurement accuracy. Here, we demonstrate that imposing different constraints on the mandible (lower jaw) can alter mouthguard kinematic accuracy in dummy headform testing. In addition, post mortem human surrogate tests utilizing the worst-case unconstrained mandible condition yield 40% and 80% normalized root mean square error in angular velocity and angular acceleration respectively. These errors can be modeled using a simple spring-mass system in which the soft mouthguard material near the sensors acts as a spring and the mandible as a mass. However, the mouthguard can be designed to mitigate these disturbances by isolating sensors from mandible loads, improving accuracy to below 15% normalized root mean square error in all kinematic measures. Thus, while current mouthguards would suffer from measurement errors in the worst-case unconstrained mandible condition, future mouthguards should be designed to account for these disturbances and future validation testing should include unconstrained mandibles to ensure proper accuracy.

Did the crew of the submarine H.L. Hunley suffocate?

On the evening of February 17th, 1864, the Confederate submarine H.L. Hunley attacked the Union ship USS Housatonic outside Charleston, South Carolina and became the first submarine in history to successfully sink an enemy ship in combat. One hypothesis for the sinking of the Confederate submarine H.L. Hunley is that the crew, in the enclosed vessel, suffered a lack of oxygen and suffocated. This study estimates the effects of hypoxia and hypercapnia on the crew based on submarine gas volume and crew breathing dynamics. The calculations show the crew of the Hunley had a minimum of 10 min between the onset of uncomfortable hypercapnia symptoms and danger of loss of consciousness from hypoxia. Based on this result and the location of the crew when discovered, hypoxia and hypercapnia do not explain the sinking of the world's first successful combat submarine.

Human Injury Criteria for Underwater Blasts

Underwater blasts propagate further and injure more readily than equivalent air blasts. Development of effective personal protection and countermeasures, however, requires knowledge of the currently unknown human tolerance to underwater blast. Current guidelines for prevention of underwater blast injury are not based on any organized injury risk assessment, human data or experimental data. The goal of this study was to derive injury risk assessments for underwater blast using well-characterized human underwater blast exposures in the open literature. The human injury dataset was compiled using 34 case reports on underwater blast exposure to 475 personnel, dating as early as 1916. Using severity ratings, computational reconstructions of the blasts, and survival information from a final set of 262 human exposures, injury risk models were developed for both injury severity and risk of fatality as functions of blast impulse and blast peak overpressure. Based on these human data, we found that the 50% risk of fatality from underwater blast occurred at 302±16 kPa-ms impulse. Conservatively, there is a 20% risk of pulmonary injury at a kilometer from a 20 kg charge. From a clinical point of view, this new injury risk model emphasizes the large distances possible for potential pulmonary and gut injuries in water compared with air. This risk value is the first impulse-based fatality risk calculated from human data. The large-scale inconsistency between the blast exposures in the case reports and the guidelines available in the literature prior to this study further underscored the need for this new guideline derived from the unique dataset of actual injuries in this study.

Underwater blast injury: a review of standards

The first cases of underwater blast injury appeared in the scientific literature in 1917, and thousands of service members and civilians were injured or killed by underwater blast during WWII. The prevalence of underwater blast injuries and occupational blasting needs led to the development of many safety standards to prevent injury or death. Most of these standards were not supported by experimental data or testing. In this review, we describe existing standards, discuss their origins, and we comprehensively compare their prescriptions across standards. Surprisingly, we found that most safety standards had little or no scientific basis, and prescriptions across standards often varied by at least an order of magnitude. Many published standards traced back to a US Navy 500 psi guideline, which was intended to provide a peak pressure at which injuries were likely to occur. This standard itself seems to have been based upon a completely unfounded assertion that has propagated throughout the literature in subsequent years. Based on the limitations of the standards discussed, we outline future directions for underwater blast injury research, such as the compilation of epidemiological data to examine actual injury risk by human beings subjected to underwater blasts.

Material characterization of in vivo and in vitro porcine brain using shear wave elasticity

Realistic computer simulation of closed head trauma requires accurate mechanical properties of brain tissue, ideally in vivo. A substantive deficiency of most existing experimental brain data is that properties were identified through in vitro mechanical testing. This study develops a novel application of shear wave elasticity imaging to assess porcine brain tissue shear modulus in vivo. Shear wave elasticity imaging is a quantitative ultrasound technique that has been used here to examine changes in brain tissue shear modulus as a function of several experimental and physiologic parameters. Animal studies were performed using two different ultrasound transducers to explore the differences in physical response between closed skull and open skull arrangements. In vivo intracranial pressure in four animals was varied over a relevant physiologic range (2-40 mmHg) and was correlated with shear wave speed and stiffness estimates in brain tissue. We found that stiffness does not vary with modulation of intracranial pressure. Additional in vitro porcine specimens (n = 14) were used to investigate variation in brain tissue stiffness with temperature, confinement, spatial location and transducer orientation. We observed a statistically significant decrease in stiffness with increased temperature (23%) and an increase in stiffness with decreasing external confinement (22-37%). This study determined the feasibility of using shear wave elasticity imaging to characterize porcine brain tissue both in vitro and in vivo. Our results underline the importance of temperature- and skull-derived boundary conditions to brain stiffness and suggest that physiologic ranges of intracranial pressure do not significantly affect in situ brain tissue properties. Shear wave elasticity imaging allowed for brain material properties to be experimentally characterized in a physiologic setting and provides a stronger basis for assessing brain injury in computational models.

Significant head accelerations can influence immediate neurological impairments in a murine model of blast-induced traumatic brain injury

Although blast-induced traumatic brain injury (bTBI) is well recognized for its significance in the military population, the unique mechanisms of primary bTBI remain undefined. Animate models of primary bTBI are critical for determining these potentially unique mechanisms, but the biomechanical characteristics of many bTBI models are poorly understood. In this study, we examine some common shock tube configurations used to study blast-induced brain injury in the laboratory and define the optimal configuration to minimize the effect of torso overpressure and blast-induced head accelerations. Pressure transducers indicated that a customized animal holder successfully reduced peak torso overpressures to safe levels across all tested configurations. However, high speed video imaging acquired during the blast showed significant head accelerations occurred when animals were oriented perpendicular to the shock tube axis. These findings of complex head motions during blast are similar to previous reports [Goldstein et al., 2012, "Chronic Traumatic Encephalopathy in Blast-Exposed Military Veterans and a Blast Neurotrauma Mouse Model," Sci. Transl. Med., 4(134), 134ra160; Sundaramurthy et al., 2012, "Blast-Induced Biomechanical Loading of the Rat: An Experimental and Anatomically Accurate Computational Blast Injury Model," J. Neurotrauma, 29(13), pp. 2352-2364; Svetlov et al., 2010, "Morphologic and Biochemical Characterization of Brain Injury in a Model of Controlled Blast Overpressure Exposure," J. Trauma, 69(4), pp. 795-804]. Under the same blast input conditions, minimizing head acceleration led to a corresponding elimination of righting time deficits. However, we could still achieve righting time deficits under minimal acceleration conditions by significantly increasing the peak blast overpressure. Together, these data show the importance of characterizing the effect of blast overpressure on head kinematics, with the goal of producing models focused on understanding the effects of blast overpressure on the brain without the complicating factor of superimposed head accelerations.

Injury Risk in Behind Armor Blunt Thoracic Trauma

First responders and military personnel are particularly susceptible to behind armor blunt thoracic trauma in occupational scenarios. The objective of this study was to develop an armored thorax injury risk criterion for short duration ballistic impacts. 9 cadavers and 2 anthropomorphic test dummies (AUSMAN and NIJ 0101.04 surrogate) were tested over a range of velocities encompassing low severity impacts, medium severity impacts, and high severity impacts based upon risk of sternal fracture. Thoracic injuries ranged from minor skin abrasions (abbreviated injury scale [AIS] 1) to severe sternal fractures (AIS 3+) and were well correlated with impact velocity and bone mineral density. 8 male cadavers were used in the injury risk criterion development. A 50% risk of AIS 3+ injury corresponded to a peak impact force of 24,900 +/- 1,400 N. The AUSMAN impact force correlated strongly with impact velocity. Recommendations to improve the biofidelity of the AUSMAN include implementing more realistic viscera and decreasing the skin thickness.

Three-dimensional adult male head and skull contours

OBJECTIVE

Traumatic brain injury (TBI) is a major public health issue, affecting millions of people annually. Anthropomorphic test devices (ATDs) and finite element models (FEMs) provide a means of understanding factors leading to TBI, potentially reducing the occurrence. Thus, there is a need to ensure that these tools accurately model humans. For example, the Hybrid III was not based on 3-dimensional human head shape data. The objective of this study is to produce average head and skull contours for an average U.S. male that can be used for ATDs and FEMs.

METHODS

Computed tomography (CT) scans of adult male heads were obtained from a database provided by the University of Virginia Center for Applied Biomechanics. An orthographic viewer was used to extract head and skull contours from the CT scans. Landmarks were measured graphically using HyperMesh (Altair, HyperWorks). To determine the head occipital condyle (OC) centroid, surface meshes of the OCs were made and the centroid of the surfaces was calculated. The Hybrid III contour was obtained using a MicroScribe Digitizer (Solution Technologies, Inc., Oella, MD). Comparisons of the average male and ATD contours were performed using 2 methods: (1) the midsagittal and midcoronal ATD contours relative to the OC centroid were compared to the corresponding 1 SD range of the average male contours; (2) the ATD sagittal contour was translated relative to the average male sagittal contour to minimize the area between the 2 contours.

RESULTS

Average male head and skull contours were created. Landmark measurements were made for the dorsum sellae, nasion skin, nasion bone, infraorbital foramen, and external auditory meatus, all relative to the OC centroid. The Hybrid III midsagittal contour was outside the 1 SD range for 15.2 percent of the average male head contour but only by a maximum distance of 1.5 mm, whereas the Hybrid III midcoronal head contour was outside the 1 SD range for 12.2 percent of the average male head contour by a maximum distance of 2 mm. Minimization of the area between the midsagittal contours resulted in only 2.3 mm of translation, corroborating the good correlation between the contours established by initial comparison.

CONCLUSIONS

Three-dimensional average male head and skull contours were created and measurements of landmark locations were made. It was found that the 50th percentile male Hybrid III corresponds well to the average male head contour and validated its 3D shape. Average adult head and skull contours and landmark data are available for public research use at http://biomechanics.pratt.duke.edu/data .

Pediatric head and neck dynamics in frontal impact: analysis of important mechanical factors and proposed neck performance corridors for 6- and 10-year-old ATDs

OBJECTIVE

Traumatic injuries are the leading cause of death of children aged 1-19 in the United States and are principally caused by motor vehicle collisions, with the head being the primary region injured. The neck, though not commonly injured, governs head kinematics and thus influences head injury. Vehicle improvements necessary to reduce these injuries are evaluated using anthropomorphic testing devices (ATDs). Current pediatric ATD head and neck properties were established by scaling adult properties using the size differences between adults and children. Due to the limitations of pediatric biomechanical research, computational models are the only available methods that combine all existing data to produce injury-relevant biofidelity specifications for ATDs. The purpose of this study is to provide the first frontal impact biofidelity corridors for neck flexion response of 6- and 10-year-olds using validated computational models, which are compared to the Hybrid III (HIII) ATD neck responses and the Mertz flexion corridors.

METHODS

Our virtual 6- and 10-year-old head and neck multibody models incorporate pediatric biomechanical properties obtained from pediatric cadaveric and radiological studies, include the effect of passive and active musculature, and are validated with data including pediatric volunteer 3 g dynamic frontal impact responses. We simulate ATD pendulum tests-used to calibrate HIII neck bending stiffness-to compare the pediatric model and HIII ATD neck bending stiffness and to compare the model flexion bending responses with the Mertz scaled neck flexion corridors. Additionally, pediatric response corridors for pendulum calibration tests and high-speed (15 g) frontal impacts are estimated through uncertainty analyses on primary model variables, with response corridors calculated from the average ± SD response over 650 simulations.

RESULTS AND CONCLUSIONS

The models are less stiff in dynamic anterioposterior bending than the ATDs; the secant stiffness of the 6- and 10-year-old models is 53 and 67 percent less than that of the HIII ATDs. The ATDs exhibit nonlinear stiffening and the models demonstrate nonlinear softening. Consequently, the models do not remain within the Mertz scaled flexion bending corridors. The more compliant model necks suggest an increased potential for head impact via larger head excursions. The pediatric anterioposterior bending corridors developed in this study are extensible to any frontal loading condition through calculation and sensitivity analysis. The corridors presented in this study are the first based on pediatric cadaveric data and provide the basis for future, more biofidelic, designs of 6- and 10-year-old ATD necks.

Importance of muscle activations for biofidelic pediatric neck response in computational models

OBJECTIVE

During dynamic injury scenarios, such as motor vehicle crashes, neck biomechanics contribute to head excursion and acceleration, influencing head injuries. One important tool in understanding head and neck dynamics is computational modeling. However, realistic and stable muscle activations for major muscles are required to realize meaningful kinematic responses. The objective was to determine cervical muscle activation states for 6-year-old, 10-year-old, and adult 50th percentile male computational head and neck models. Currently, pediatric models including muscle activations are unable to maintain the head in an equilibrium position, forcing models to begin from nonphysiologic conditions. Recent work has realized a stationary initial geometry and cervical muscle activations by first optimizing responses against gravity. Accordingly, our goal was to apply these methods to Duke University's head-neck model validated using living muscle response and pediatric cadaveric data.

METHODS

Activation schemes maintaining an upright, stable head for 22 muscle pairs were found using LS-OPT. Two optimization problems were investigated: a relaxed state, which minimized muscle fatigue, and a tensed activation state, which maximized total muscle force. The model's biofidelity was evaluated by the kinematic response to gravitational and frontal impact loading conditions. Model sensitivity and uncertainty analyses were performed to assess important parameters for pediatric muscle response. Sensitivity analysis was conducted using multiple activation time histories. These included constant activations and an optimal muscle activation time history, which varied the activation level of flexor and extensor groups, and activation initiation and termination times.

RESULTS

Relaxed muscle activations decreased with increasing age, maintaining upright posture primarily through extensor activation. Tensed musculature maintained upright posture through coactivation of flexors and extensors, producing up to 32 times the force of the relaxed state. Without muscle activation, the models fell into flexion due to gravitational loading. Relaxed musculature produced 28.6-35.8 N of force to the head, whereas tensed musculature produced 450-1023 N. Pediatric model stiffnesses were most sensitive to muscle physiological cross-sectional area.

CONCLUSIONS

Though muscular loads were not large enough to cause vertebral compressive failure, they would provide a prestressed state that could protect the vertebrae during tensile loading but might exacerbate risk during compressive loading. For example, in the 10-year-old, a load of 602 N was produced, though estimated compressive failure tolerance is only 2.8 kN. Including muscles and time-variant activation schemes is vital for producing biofidelic models because both vary by age. The pediatric activations developed represent physiologically appropriate sets of initial conditions and are based on validated adult cadaveric data.

How few? Bayesian statistics in injury biomechanics

In injury biomechanics, there are currently no general a priori estimates of how few specimens are necessary to obtain sufficiently accurate injury risk curves for a given underlying distribution. Further, several methods are available for constructing these curves, and recent methods include Bayesian survival analysis. This study used statistical simulations to evaluate the fidelity of different injury risk methods using limited sample sizes across four different underlying distributions. Five risk curve techniques were evaluated, including Bayesian techniques. For the Bayesian analyses, various prior distributions were assessed, each incorporating more accurate information. Simulated subject injury and biomechanical input values were randomly sampled from each underlying distribution, and injury status was determined by comparing these values. Injury risk curves were developed for this data using each technique for various small sample sizes; for each, analyses on 2000 simulated data sets were performed. Resulting median predicted risk values and confidence intervals were compared with the underlying distributions. Across conditions, the standard and Bayesian survival analyses better represented the underlying distributions included in this study, especially for extreme (1, 10, and 90%) risk. This study demonstrates that the value of the Bayesian analysis is the use of informed priors. As the mean of the prior approaches the actual value, the sample size necessary for good reproduction of the underlying distribution with small confidence intervals can be as small as 2. This study provides estimates of confidence intervals and number of samples to allow the selection of the most appropriate sample sizes given known information.

Attenuation of blast pressure behind ballistic protective vests

BACKGROUND

Clinical studies increasingly report brain injury and not pulmonary injury following blast exposures, despite the increased frequency of exposure to explosive devices. The goal of this study was to determine the effect of personal body armour use on the potential for primary blast injury and to determine the risk of brain and pulmonary injury following a blast and its impact on the clinical care of patients with a history of blast exposure.

METHODS

A shock tube was used to generate blast overpressures on soft ballistic protective vests (NIJ Level-2) and hard protective vests (NIJ Level-4) while overpressure was recorded behind the vest.

RESULTS

Both types of vest were found to significantly decrease pulmonary injury risk following a blast for a wide range of conditions. At the highest tested blast overpressure, the soft vest decreased the behind armour overpressure by a factor of 14.2, and the hard vest decreased behind armour overpressure by a factor of 56.8. Addition of body armour increased the 50th percentile pulmonary death tolerance of both vests to higher levels than the 50th percentile for brain injury.

CONCLUSIONS

These results suggest that ballistic protective body armour vests, especially hard body armour plates, provide substantial chest protection in primary blasts and explain the increased frequency of head injuries, without the presence of pulmonary injuries, in protected subjects reporting a history of blast exposure. These results suggest increased clinical suspicion for mild to severe brain injury is warranted in persons wearing body armour exposed to a blast with or without pulmonary injury.

A Multiscale Approach to Blast Neurotrauma Modeling: Part I - Development of Novel Test Devices for in vivo and in vitro Blast Injury Models

The loading conditions used in some current in vivo and in vitro blast-induced neurotrauma models may not be representative of real-world blast conditions. To address these limitations, we developed a compressed-gas driven shock tube with different driven lengths that can generate Friedlander-type blasts. The shock tube can generate overpressures up to 650 kPa with durations between 0.3 and 1.1 ms using compressed helium driver gas, and peak overpressures up to 450 kPa with durations between 0.6 and 3 ms using compressed nitrogen. This device is used for short-duration blast overpressure loading for small animal in vivo injury models, and contrasts the more frequently used long duration/high impulse blast overpressures in the literature. We also developed a new apparatus that is used with the shock tube to recreate the in vivo intracranial overpressure response for loading in vitro culture preparations. The receiver device surrounds the culture with materials of similar impedance to facilitate the propagation of a single overpressure pulse through the tissue. This method prevents pressure waves reflecting off the tissue that can cause unrealistic deformation and injury. The receiver performance was characterized using the longest helium-driven shock tube, and produced in-fluid overpressures up to 1500 kPa at the location where a culture would be placed. This response was well correlated with the overpressure conditions from the shock tube (R² = 0.97). Finite element models of the shock tube and receiver were developed and validated to better elucidate the mechanics of this methodology. A demonstration exposing a culture to the loading conditions created by this system suggest tissue strains less than 5% for all pressure levels simulated, which was well below functional deficit thresholds for strain rates less than 50 s⁻¹. This novel system is not limited to a specific type of culture model and can be modified to reproduce more complex pressure pulses.

A Multiscale Approach to Blast Neurotrauma Modeling: Part II: Methodology for Inducing Blast Injury to in vitro Models

Due to the prominent role of improvised explosive devices (IEDs) in wounding patterns of U.S. war-fighters in Iraq and Afghanistan, blast injury has risen to a new level of importance and is recognized to be a major cause of injuries to the brain. However, an injury risk-function for microscopic, macroscopic, behavioral, and neurological deficits has yet to be defined. While operational blast injuries can be very complex and thus difficult to analyze, a simplified blast injury model would facilitate studies correlating biological outcomes with blast biomechanics to define tolerance criteria. Blast-induced traumatic brain injury (bTBI) results from the translation of a shock wave in-air, such as that produced by an IED, into a pressure wave within the skull-brain complex. Our blast injury methodology recapitulates this phenomenon in vitro, allowing for control of the injury biomechanics via a compressed-gas shock tube used in conjunction with a custom-designed, fluid-filled receiver that contains the living culture. The receiver converts the air shock wave into a fast-rising pressure transient with minimal reflections, mimicking the intracranial pressure history in blast. We have developed an organotypic hippocampal slice culture model that exhibits cell death when exposed to a 530 ± 17.7-kPa peak overpressure with a 1.026 ± 0.017-ms duration and 190 ± 10.7 kPa-ms impulse in-air. We have also injured a simplified in vitro model of the blood-brain barrier, which exhibits disrupted integrity immediately following exposure to 581 ± 10.0 kPa peak overpressure with a 1.067 ± 0.006-ms duration and 222 ± 6.9 kPa-ms impulse in-air. To better prevent and treat bTBI, both the initiating biomechanics and the ensuing pathobiology must be understood in greater detail. A well-characterized, in vitro model of bTBI, in conjunction with animal models, will be a powerful tool for developing strategies to mitigate the risks of bTBI.

Pediatric head contours and inertial properties for ATD design

Child head trauma in the United States is responsible for 30% of all childhood injury deaths with costs estimated at $10 billion per year. The common tools for studying this problem are the child anthropomorphic test devices (ATDs). The headform sizes and structural properties of child ATDs are based on various anthropometric studies and scaled Hybrid III mass and center of gravity (CG) properties. The goals of this study were to produce pediatric head and skull contours, provide estimates of pediatric head mass, mass moment of inertia and CG locations, and compare the head contours with the current child ATD head designs. To that end, computer tomography (CT) scans from one hundred eighty-five children in twelve age groups were analyzed to develop three-dimensional head and skull contours. The contours were averaged to estimate head and skull contours for children aged 1-month to 10-years. Inertial properties were estimated from a small sample of post- mortem human subjects (PMHSs). This paper provides new equations for estimating the moments of inertia and anatomical landmarks in the head. There were reasonable agreement between the estimates for head masses obtained from analysis of the CT scans of the PMHS heads and the estimates obtained using the volumetric scaling rule used in ATD design work. The regression of the pediatric head sizes was found to be non-linear, with different regression slope for ages 1M to 18M and 18M to 120M. The 12M CRABI and 36M Hybrid III heads were found to be different by 10 and 18mm, respectively, from the average human CT contours due to the differences in the occipital condyle placement relative to the nasion.

Drosophila melanogaster larvae as a model for blast lung injury

BACKGROUND

Primary blast injuries, specifically lung injuries, resulting from blast overpressure exposures are a major source of mortality for victims of blast events. However, existing pulmonary injury criteria are inappropriate for common exposure environments. This study uses Drosophila melanogaster larvae to develop a simple phenomenological model for human pulmonary injury from primary blast exposure.

METHODS

Drosophila larvae were exposed to blast overpressures generated by a 5.1-cm internal diameter shock tube and their mortality was observed after the exposure. To establish mortality thresholds, a survival analysis was conducted using survival data and peak incident pressures. In addition, a histologic analysis was performed on the larvae to establish the mechanisms of blast injury.

RESULTS

The results of the survival analysis suggest that blast overpressure for 50% Drosophila survival is greater than human threshold lung injury and is similar to human 50% survival levels, in the range of overpressure durations tested (1-5 ms). A "parallel" analysis of the Bass et al. 50% human survival curves indicates that 50% Drosophila survival is equivalent to a human injury resulting in a 69% chance of survival. Histologic analysis of the blast-exposed larvae failed to demonstrate damage to the dorsal trunk of the tracheal system; however, the presence of flocculent material in the larvae body cavities and tracheas suggests tissue damage.

CONCLUSIONS

This study shows that D. melanogaster survival can be correlated with large animal injury models to approximate a human blast lung injury tolerance. Within the range of durations tested, Drosophila larvae may be used as a simple model for blast injury.

Comparison of Hybrid III child test dummies to pediatric PMHS in blunt thoracic impact response

The limited availability of pediatric biomechanical impact response data presents a significant challenge to the development of child dummies. In the absence of these data, the development of the current generation of child dummies has been driven by scaling of the biomechanical response requirements of the existing adult test dummies. Recently published pediatric blunt thoracic impact response data provide a unique opportunity to evaluate the efficacy of these scaling methodologies. However, the published data include several processing anomalies and nonphysical features. These features are corrected by minimizing instrumentation and processing error to improve the fidelity of the individual force-deflection responses. Using these data, biomechanical impact response corridors are calculated for a 3-year-old child and a 6-year-old child. These calculated corridors differ from both the originally published postmortem human subject (PMHS) corridors and the impact response requirements of the current child dummies. Furthermore, the response of the Hybrid III 3-year-old test dummy in the same impact condition shows a similar deflection but a significantly higher force than the 3-year-old corridor. The response of the Hybrid III 6-year-old dummy, on the other hand, correlates well with the calculated 6-year-old corridor. The newly developed 3-year-old and 6-year-old blunt thoracic impact response corridors can be used to define data-driven impact response requirements as an alternative to scaling-driven requirements.

Kinematic response of the spine during simulated aircraft ejections

INTRODUCTION

Military aviators are susceptible to spinal injuries during high-speed ejection scenarios. These injuries commonly arise as a result of strains induced by extreme flexion or compression of the spinal column. This study characterizes the vertebral motion of two postmortem human surrogates (PMHS) during a simulated catapult phase of ejection on a horizontal decelerator sled.

METHODS

During testing, the PMHS were restrained supinely to a mock ejection seat and subjected to a horizontal deceleration profile directed along the local z-axis. Two midsized males (175.3 cm, 77.1 kg; 185.4 cm, 72.6 kg) were tested. High-rate motion capture equipment was used to measure the three-dimensional displacement of the head, vertebrae, and pelvis during the ejection event.

RESULTS

The two PMHS showed generally similar kinematic motion. Head injury criterion (HIC) results were well below injury threshold levels for both specimens. The specimens both showed compression of the spine, with a reduction in length of 23.9 mm and 45.7 mm. Post-test autopsies revealed fractures in the C5, T1, and L1 vertebrae.

DISCUSSION

This paper provides an analysis of spinal motion during an aircraft ejection.The injuries observed in the test subjects were consistent with those seen in epidemiological studies. Future studies should examine the effects of gender, muscle tensing, out-of-position (of head from neutral position) occupants, and external forces (e.g., windblast) on spinal kinematics during aircraft ejection.

Re-evaluating the neck injury index (NII) using experimental PMHS tests

OBJECTIVE

The neck injury index, NII, developed in ISO 13232 (2005) as a testing and evaluation procedure for assessing the risk of injury to the AO/C1/C2 region of the cervical spine in motorcycle riders is reevaluated using an existing postmortem human subjects (PMHS) data set and resulting in a reformulated NII criterion applicable to PMHS tests.

METHODS

A recent series of 36 PMHS head/neck component tests was used to examine the risk of neck injury in frontal impacts and to assess the predictive capability of NII for impacts of various orientations. Using force and moment load cell PMHS experimental data, injury risk was assessed using NII evaluated with the ISO 13232-5 algorithms.

RESULTS

The injury risk predictions are compared with the injury outcomes from the head/neck PMHS. The NII criterion underestimated the injury incidence of the PMHS experimental group. The average predicted risk of injuries for the experimental injury tests based on NII across the MAIS levels was 0.7 percent, though there were 11 AIS 3+ injuries observed in the actual testing (30.6%). Using the experimental injury outcomes and the experimental force and moment time histories, the normalizing coefficients from NII are reevaluated to minimize the difference between NII risk assessment and the experimental injury outcome in the least squares (L(2)) basis. This reanalysis is compared with existing human and PMHS neck injury criteria.

CONCLUSIONS

By reanalyzing the NII formulation using an existing PMHS injury data set with known forces and moments and known injury outcomes, a new NII(PMHS) is developed that uses PMHS loads to predict injury. This reformulation removes the dependency of the original NII formulation on the forces and moments from motorcyclist anthropomorphic test device (MATD) experiments and simulations yet retains the advantages of the multi-axial neck injury criterion.

Pediatric thoracoabdominal biomechanics

No experimental data exist quantifying the force-deformation behavior of the pediatric chest when subjected to non-impact, dynamic loading from a diagonal belt or a distributed loading surface. Kent et al. (2006) previously published juvenile abdominal response data collected using a porcine model. This paper reports on a series of experiments on a 7-year-old pediatric post-mortem human subject (PMHS) undertaken to guide the scaling of existing adult thoracic response data for application to the child and to assess the validity of the porcine abdominal model. The pediatric PMHS exhibited abdominal response similar to the swine, including the degree of rate sensitivity. The upper abdomen of the PMHS was slightly stiffer than the porcine behavior, while the lower abdomen of the PMHS fit within the porcine corridor. Scaling of adult thoracic response data using any of four published techniques did not successfully predict the pediatric behavior. All of the scaling techniques intrinsically reduce the stiffness of the adult response, when in reality the pediatric subject was as stiff as, or slightly more stiff than, published adult corridors. An assessment of age-related changes in thoracic stiffness indicated that for both a CPR patient population and dynamic diagonal belt loading on a PMHS population, the effective stiffness of the chest increases through the fourth decade of life and then decreases, resulting in stiffness values approximately the same for children and for elderly adults. Additional research is needed to elucidate the generality of this finding and to assess its significance for scaling adult data to represent pediatric responses.

The transient relationship between pressure and volume in the pediatric pulmonary system

An accurate understanding of the relationship between pulmonary pressure and volume is required for modeling pulmonary mechanics in a variety of clinical applications. In this study the experimental techniques and mathematical formulations used to characterize viscoelastic materials are applied to characterize transient pulmonary compliance in juvenile swine. Fixed volumes of air were insufflated into 5 swine and held constant for 45 s while the transient decay in tracheal pressure was measured. An analytical model was developed using an optimization scheme that maximized the model fit to the experimental data over the entire time convolution. The initial injected volume was varied to assess the spatial and temporal linearity of the behavior. Model performance was assessed by comparing measured and predicted pressure during insufflations of erratic volume waveforms. It is concluded that the pulmonary impedance of healthy juveniles can be adequately described over a wide volume and frequency range using a relatively simple 5-parameter model that is linear both spatially and temporally.

Viscoelastic response of the thorax under dynamic belt loading

OBJECTIVE

Three postmortem human surrogates (PMHS) were positioned and rigidly mounted through the spine to a tabletop test fixture for the purpose of characterizing thoracic response to diagonal belt loading with well-defined boundary conditions.

METHODS

These PMHS were mounted to a stationary apparatus that supported the spine and shoulders in a configuration comparable to that seen in a 48 km/h automobile sled test at the time of maximum chest deformation. A belt restraint was positioned across the anterior torso with attachments at D-ring and buckle locations based on the geometry of a mid-sized sedan. The belt was attached to a trolley driven by a hydraulic ram linked to a universal test machine. Ramp and hold experiments were conducted at rates of 0.5, 0.9, and 1.2 m/s and hold times of 60 s. Ramp-hold displacement waveforms of up to 20 percent of the chest depth were applied to the chest while the resulting belt loads and spinal reaction loads were recorded. These data were used to identify parameters in a seven-parameter thoracic structural model mathematically analogous to a viscoelastic material model. A final test with 40 percent deflection was performed at the completion of the loading sequence.

RESULTS

Model fits to ramps of different magnitudes indicated that the assumption of temporal linearity was reasonable over the range of inputs in this study. In agreement with previous studies, the spatial (force-deflection) response was only slightly nonlinear, indicating that a fully linear model would be reasonable up to the deflection levels used here.

CONCLUSIONS

Pronounced variability in the instantaneous elastic behavior was observed among the three test subjects, whereas the relaxation behavior exhibited less variability.

The temperature-dependent viscoelasticity of porcine lumbar spine ligaments

STUDY DESIGN

A uniaxial tensile loading study of 13 lumbar porcine ligaments under varying environmental temperature conditions.

OBJECTIVES

To investigate a possible temperature dependence of the material behavior of porcine lumbar anterior longitudinal ligaments.

SUMMARY OF BACKGROUND DATA

Temperature dependence of the mechanical material properties of ligament has not been conclusively established.

METHODS

The anterior longitudinal ligaments (ALLs) from domestic pigs (n = 5) were loaded in tension to 20% strain using a protocol that included fast ramp/hold and sinusoidal tests. These ligaments were tested at temperatures of 37.8 degrees C, 29.4 degrees C, 21.1 degrees C, 12.8 degrees C, and 4.4 degrees C. The temperatures were controlled to within 0.6 degrees C, and ligament hydration was maintained with a humidifier inside the test chamber and by spraying 0.9% saline onto the ligament. A viscoelastic model was used to characterize the force response of the ligaments.

RESULTS

The testing indicated that the ALL has strong temperature dependence. As temperature decreased, the peak forces increased for similar input peak strains and strain rates. The relaxation of the ligaments was similar at each temperature and showed only weak temperature dependence. Predicted behavior using the viscoelastic model compared well with the actual data (R2 values ranging from 0.89 to 0.99). A regression analysis performed on the viscoelastic model coefficients confirmed that relaxation coefficients were only weakly temperature dependent while the instantaneous elastic function coefficients were strongly temperature dependent.

CONCLUSIONS

The experiment demonstrated that the viscoelastic mechanical response of the porcine ligament is dependent on the temperature at which it is tested; the force response of the ligament increased as the temperature decreased. This conclusion also applies to human ligaments owing to material and structural similarity. This result settles a controversy on the temperature dependence of ligament in the available literature. The ligament viscoelastic model shows a significant temperature dependence on the material properties; instantaneous elastic force was clearly temperature dependent while the relaxation response was only weakly temperature dependent. This result suggests that temperature dependence should be considered when testing ligaments and developing material models for in vivo force response, and further suggests that previously published material property values derived from room temperature testing may not adequately represent in vivo response. These findings have clinical relevance in the increased susceptibility of ligamentous injury in the cold and in assessing the mechanical behavior of cold extremities and extremities with limited vascular perfusion such as those of the elderly.

Failure properties of cervical spinal ligaments under fast strain rate deformations

STUDY DESIGN

The failure responses of the anterior longitudinal ligament, posterior longitudinal ligament, and ligamentum flavum were examined in vitro under large strain-rate mechanical loading.

OBJECTIVE

To quantify the failure properties for 3 cervical spinal ligaments at strain rates associated with traumatic events.

SUMMARY OF BACKGROUND DATA

There exists little experimentation literature for fast-rate loading of the cervical spine ligaments. The small amount of available information is framed only in extensive experimental coordinates, and not in the context of strains.

METHODS

Bone-ligament-bone complexes were strained at fast rates, in an incrementally increasing loading protocol using a servohydraulic mechanical test frame. Failure loads and displacements were converted to engineering and true stress and strain values, and compared for the different ligaments (anterior longitudinal ligament, posterior longitudinal ligament, and ligamentum flavum), spinal levels (C3-C4, C5-C6, and C7-T1), and for male versus female specimens.

RESULTS

There were no significant differences in force or true stress for gender or spinal level. There was a significant difference in force and true stress for ligament type. A difference was found between the posterior longitudinal ligament and ligamentum flavum for failure force, and between the ligamentum flavum and both the anterior and posterior longitudinal ligaments for failure true stress. No significant differences were found in true strain for ligament, gender, or spinal level. The mean ligament failure true strain was 0.81. Failure true strains were approximately 57% of the failure engineering strains.

CONCLUSIONS

Once the injury mechanisms of the cervical spine are fully understood, computational models can be employed to understand the potentially traumatic effects of clinical procedures, and mitigate injury in impact, falls, and other high-rate scenarios. The soft tissue failure properties in this study can be used to develop failure tolerances in fast-rate loading scenarios. Failure properties of the anterior and posterior longitudinal ligaments were similar, and the same properties can be used to model both ligaments.

Upper extremity interaction with a helicopter side airbag: injury criteria for dynamic hyperextension of the female elbow joint

This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments.

Muscle tetanus and loading condition effects on the elastic and viscous characteristics of the thorax

Thoracic deformation under an applied load is an established indicator of injury risk, but the force required to achieve an injurious level of deformation currently is not understood adequately. This article evaluates how two potentially important factors, loading condition and muscle tensing, affect the structural response of the dynamically loaded thorax. Structural models of two human cadaver thoraxes and two porcine thoraxes were used to quantify the effects. The human cadavers, which represent anthropometric extremes, were subjected to anterior loading from (1) a 5.1-cm-wide belt oriented diagonally (i.e., seatbelt-like loading), (2) a 15.2-cm-diameter rigid hub, and (3) a 20.3-cm-wide belt oriented laterally (i.e., a distributed load). A structural model having the mathematical formulation of a quasilinear viscoelastic material model was used to model the elastic and viscous response, with ramp-hold tests used to determine the model coefficients. The effect of thoracic musculature was assessed using similar ramp-hold tests on the porcine subjects, each with and without forced muscle contraction. Even maximally contracted thoracic musculature is shown to have a minimal effect on the response, with similar elastic and viscous characteristics exhibited by each subject regardless of muscle tone. The elastic response is shown to be approximately a factor of three stiffer for diagonal belt loading and for this distributed loading condition than for the hub loading, indicating that the response is influenced most by the particular anatomical structures that are engaged and, secondarily, by the area of load application. Specifically, shoulder involvement is shown to have a strong influence. The force relaxation is found to be pronounced, but insensitive to the loading condition, with long-time force relaxation coefficients (G( infinity )) in the range of 0.1 to 0.3. The findings of this study provide restraint-specific guidelines for the force-deflection characteristics of both physical and computational thoracic models.

The development, validation and application of a finite element upper extremity model subjected to air bag loading

Both frontal and side air bags can inflict injuries to the upper extremities in cases where the limb is close to the air bag module at the time of impact. Current dummy limbs show qualitatively correct kinematics under air bag loading, but they lack biofidelity in long bone bending and fracture. Thus, an effective research tool is needed to investigate the injury mechanisms involved in air bag loading and to judge the improvements of new air bag designs. The objective of this study is to create an efficient numerical model that exhibits both correct global kinematics as well as localized tissue deformation and initiation of fracture under various impact conditions. The development of the model includes the creation of a sufficiently accurate finite element mesh, the adaptation of material properties from literature into constitutive models and the definition of kinematic constraints at articular joint locations. In order to make the model applicable for full-scale simulations, it was coupled with a computationally efficient human model. The model was validated against available cadaver experiments, including static and dynamic three-point-bending tests to the arm and forearm, as well as frontal air bag to forearm impact tests. The sensitivity of the model to changes in air bag properties and upper limb orientation are demonstrated by performing parametric studies. It is shown that the risk of forearm fracture increases substantially with proximity to the deploying frontal air bag and air bag aggressiveness, which corresponds to experimental findings. However, it is shown that increasing the forearm supination angle is protective for the occurrence of forearm fracture. In conclusion, the developed model proves to be a useful research tool to investigate trends in injury severity as a result of a changing frontal air bag to upper extremity loading environment.